Since establishing ProSTAT in 1995, I have had the pleasure of working for more than 325 hospitals/health systems, physician-owned and Certified Registered Nurse Anesthetist (CRNA)-owned anesthesia practices, academic medical centers and related anesthesia businesses in 46 states and the District of Columbia. My consulting business has evolved over the years from an exclusive focus on anesthesia group practice to one that now include hospitals and health systems (just over 150 at last count). That evolution has helped me better understand the viewpoints and value structure of hospital leaders as I spend time in their offices now discussing anesthesia challenges, solutions and strategies for the future with their perspective in mind. It is the substance of those detailed discussions that I hope to share with you in this article. Five to ten years ago, I feel safe in saying, many (though not all) anesthesia practices didn’t place a top priority on what...

It is rare that a patient’s conduct drives his or her physician to terminate the relationship, but it does happen—not necessarily in anesthesiology care, where ongoing patient relationships are the exception, but certainly in chronic pain practices.  Such an ending is uncomfortable for all the parties involved.  There are ways, however, to make the process smoother and less fraught with risk for the practice. First, what is the risk?  Medical ethics and the medico-legal theory of abandonment establish the principle that once a patient engages a physician, that physician is under an obligation to provide the patient with continuous care and attention until the relationship is properly terminated.  The patient may terminate at any time, for any reason.  At least in those states that do not have legislation limiting the circumstances in which the physician may discharge a patient unilaterally, the physician may terminate for any non-discriminatory reason as long as...

CMS has raised hackles in the physician community by finalizing its proposal to eliminate 10- and 90-day global surgical periods beginning in 2017 (Final Fee Schedule Rule).  All procedures would have a zero-day global period by 2018.  While the change will not affect anesthesia services or most pain medicine practices, it is of great concern to surgeons—and their anesthesiology colleagues should therefore be conversant with the issues. The Global Surgical Package The global surgical package includes all necessary services normally furnished by a surgeon before, during and after a procedure.  Medicare payment for the surgical procedure includes the preoperative, intra-operative and postoperative services routinely performed by the surgeon or by members of the same group with the same specialty, whether provided in the inpatient, outpatient, ambulatory surgery center (ASC) or office setting.  There are no global periods for anesthesia services, but most pain medicine procedures are subject to the policy. There...

Healthcare is always changing and ambulatory surgery centers (ASCs) are in a great position to take advantage of the new care philosophy: providing the best quality for the lowest cost. However, that’s only if they can overcome some of the bigger market challenges facing ASCs today: 1. Transitioning to value-based care. ASCs traditionally depended on volume to drive their bottom line, but healthcare is moving more toward pay-for-performance instead of fee-for-service. Bundled payments, accountable care organizations (ACOs) and shared savings programs all promote outcomes over volume and require healthcare providers to take on risk. “As payers increasingly sell health plans tied to ACOs, ASCs will progressively feel compelled to participate in ACOs as well,” says Adam C. Powell, PhD, president of Payer+Provider Syndicate. “This is likely to be particularly pronounced in high-density areas in which ACOs have a strong presence. Many ASCs will have to take a serious look at how...

On Friday, October 31, CMS released the Final Rule with Revisions to Payment Policies under the Physician Fee Schedule for 2015.  Among numerous changes in the Final Rule are important modifications to the Value-Based Payment Modifier (VM). Beginning on January 1, 2015, consistent with the Affordable Care Act and CMS’ proposals, the VM will affect all eligible professionals (EPs)— anesthesiologists, nurse anesthetists and anesthesiologist assistants among them. For the great majority of anesthesia practices, the VM matters for one principal reason, that it will apply an additional payment cut to EPs who do not satisfactorily participate in the Physician Quality Reporting System (PQRS).  This cut would be four percent for groups of ten or more EPs and two percent for groups with two to nine EPs and solo practitioners.  Thus failure to report under the PQRS in 2015 could cost an EP (in a practice with ten or more EPs) a total of six...